Clinicopathological study of a patient with idiopathic villous atrophy and small vessel alterations of the ileum.

Ileal villous atrophy with normal proximal small intestinal mucosa is a rare lesion observed in a few diseases. We report here a case of unknown etiology. A 49-year-old woman presented with chronic diarrhea and steatorrhea due to bile acid malabsorption which was strikingly improved by a low-fat diet. Villous atrophy was total or subtotal, but enterocyte alterations were minimal. Crypts were hyperplastic and the lamina propria was infiltrated by lymphocytes and plasma cells mainly synthesizing IgM. These alterations were associated with the presence in the submucosa, and occasionally in the mucosa, of numerous convoluted nonectasic capillary tufts. Thrombi consisting of pure platelet aggregates were found in the capillary tufts and adjacent small vessels, whose walls were either normal or hyalinized. The patient suffered for many years from attacks of Raynaud's phenomenon and platelet aggregation was depressed in the presence of collagen. Thrombi disappeared after aspirin treatment, but the other lesions persisted at the time of death from an unrelated cause.

[Primary biliary cirrhosis and sarcoidosis. Association or unique disease?]. / Cirrhose biliaire primitive et sarcoïdose. Association ou maladie unique?

The incontestable simultaneous occurrence of primary biliary cirrhosis and sarcoidosis is reported in a 40 year-old woman. The diagnosis of primary biliary cirrhosis was based on the association of intrahepatic cholestasis, increased serum IgM, high titer of antimitochondrial antibodies and hepatic histologic lesions. In six years the latter passed from bile duct destruction with fibrosis to cirrhosis with absence of bile ducts. The diagnosis of sarcoidosis relied on the presence of bilateral hilar lymphadenopathies, pulmonary infiltrate, tuberculoid granuloma without necrosis in an enlarged cervical lymph node and increased serum level of angiotensin conversion enzyme improved by steroid therapy. Such an association, only three other cases of which have been reported, suggests a link between the two diseases, which could be two localizations of a same physiopathological process.

[Diagnosis of a fibrosarcoma of the psoas presenting with fever only by gallium citrate scintigraphy (author's transl)]. / Diagnostic d'un fibrosarcome du psoas à forme fébrile pure par la scintigraphie au citrate de gallium.

A fibrosarcoma of the psoas in a 62-year-old woman manifested itself essentially by a febrile syndrome for approximately one year. It would appear that the first manifestation of the lesion occurred three years previously (lumbar pain). Careful clinical examination, numerous radiological studies and two exploratory laparotomies failed to reveal the site of the lesion. The latter was finally demonstrated by GaC67 gammagraphy. This case thus confirms the great value of this radioactive tracer in the diagnostic study of a febrile syndrome as a tumour syndrome. It would appear to be perhaps desirable, in this pathological context, to request a whole body study using GaC67 before proceeding to exploratory laparotomy.

[Hypokalemia and hypomagnesemia in a cirrhotic patient. Correction of metabolic disorders by magnesium]. / Hypokaliémie et hypomagnésémie chez un cirrhotique. Correction des troubles métaboliques par le magnésium.

The authors report the case of a cirrhotic with severe hypokalemia (2 mEq/l) responding incompletely to attempts at correction by classical treatments. The findings of a serum and red cell magnesium deficiency led to administration of this electrolyte which proved efficacous. They then recall the mechanism of hypokalemia and hypomagnesemia in alcoholics, study the possible relationship between these abnormalities, their noxious effects and suggest a treatment.

[Massive tricuspid insufficiency during idiopathic dilatation of the right atrium. Surgical treatment. Apropos of two cases]. / Insuffisance tricuspidienne massive au cours de la dilatation idiopathique de l'oreillette droite. Traitement chirurgical. A propos de deux observations

Tricuspid incompetence occuring in isolation is extremely rare, and had only been described under certain very particular conditions: trauma, septicaemia of genital origin, intravenous injection of narcotics. Idiopathic dilatation of the auricle of the right atrium is a disorder which has been described during the last fifteen years or so, and is recognised mainly because of the disorders of rhythm which it causes. These two cases demonstrate that, in the long-term, massive dilatation of the auricle can lead to tricuspid incompetence by dilating the ring, and require surgical intervention.